Hypnotherapy

Abstract and key points

In hypnotherapy a patient attempts to enter into a trance-like state in order to cope better with complaints such as pain, anxiety and stress by actively diverting their attention towards relaxing thoughts.

Hypnotherapy is generally considered safe but is contraindicated in acute psychoses, severe personality disorders

Hypnotherapy is a procedure with which behaviour, cognition and affective patterns are influenced by means of hypnosis and the shift in consciousness it induces. This makes it possible to restructure distressing events and perceptions while supporting the biological changes needed for healing processes.

Hypnosis has been suggested to be a useful adjunct for pain reduction in cancer patients. In addition, it is mainly used for anxiety, insomnia, pain management and stress-related illnesses.

Twenty randomized clinical trials (RCTs) and two controlled clinical trials (CCTs) report on results of hypnotherapy for cancer patients. They include studies on hypnotherapy in anticipatory nausea and vomiting (ANV), pain and other symptoms. Research shows that hypnosis can reduce pain, nausea and emesis, hot flushes, fatigue and anxiety.

Hypnotherapy is considered a safe treatment modality when administered by trained professionals. Acute psychoses, severe personality disorders and an inability to be hypnotized are considered contraindications.

What is it?

Description

Hypnotherapy is a psychotherapeutic intervention using hypnosis, self-hypnosis or hypnosis therapy. Patients attempt to enter into a trance-like state in order to cope better with complaints such as anxiety and stress by actively diverting their attention towards relaxing thoughts.(1) When using hypnosis, subjects are guided by the hypnotist to respond to suggestions.(2) Hypnosis often takes the form of relaxation and imagery, incorporating suggestions which will increase comfort or transform physical sensations such as pain, cold or numbness.(3) The hypnotized person is often relaxed, but at the same time mentally alert.

Application and dosage

Classic hypnotherapy attempts to induce a state of reduced concentration to make the patient more receptive to suggestion. Occasionally, techniques for muscle relaxation are used to reinforce the effect of the hypnotherapy.(4) In addition, passive guided imagery may also be used to assist the hypnotized patient in envisioning pleasant auditory, visual and/ or kinaesthetic situations. (1, 5)

Normally, there are three main stages of the depth of trance: light, medium and deep trance. Light trance is all that is needed for medical purposes. Nearly 90% of the population has the ability to enter such a trance-like state.(6)

As a fundamental rule, people can only successfully be hypnotized if they wish to and cooperate. A willingness to cooperate and a desire to cope with complaints more effectively are prerequisites for efficacious hypnotherapy.(7)

History/providers

The term ‘hypnosis’ is derived from the Greek word ‘hypnos’, meaning ‘sleep’. The history of hypnotherapy indicates that spiritual leaders, priests, healers and philosophers were the practitioners of early forms of hypnosis.

Scottish surgeon James Braid (1795-1860) noticed that many of his patients experienced a trance-like state when they focused on one single spot for a longer period of time. He introduced the words ‘hypnosis’ and ‘hypnotism’ to the medical community. Austrian physician Franz Anton Mesmer (1734-1815) is regarded by some as the father of hypnotherapy. American psychiatrist Milton H. Erickson (1901-1980) is considered to be the founder of clinical hypnotherapy.

Claims of efficacy / alleged indications

There is a wide variety of potential applications for hypnotherapy in a medical context, including pain management, psychosomatic conditions (e.g. irritable bowel syndrome, blood pressure), prenatal courses, physical rehabilitation (e.g. strokes), and use during medical examinations or treatments.(8)

Hypnotherapy has been used in cancer care, together with other relaxation therapies, to ameliorate adverse effects resulting from cancer treatment or to help patients adjust to their disease. In some cases hypnosis is also used to complement pain treatment.(9)

Hypnosis attempts to change the negative state of mind cancer patients might experience and to give them a realistic but positive outlook. By thus providing them with a tool to feel control over their emotional symptoms, patients will be better equipped to cope with the psychological and physical consequences of the disease process.

Mechanisms of action

Current theories about hypnotherapy’s mechanisms of action are based upon newer concepts about learning and memory as well as on research about how stimuli are perceived and processed.

Hypnotherapy is intended to activate specific patterns which are critical to processes of learning and memory; it takes place in a way that facilitates people’s ability to modify their experiences and behaviours. Hypnotherapy circumvents the process of consciously addressing certain topics and content while concurrently stimulating implicit learning processes and making it easier to ignore disruptive stimuli.(10)

Prevalence of use

A systematic review of prevalence data about cancer patients’ use of complementary and alternative medicine estimates that around the world, between 0.5 and 11% of cancer patients use hypnotherapy.(11)

Legal issues

Both the British and American Medical Associations officially recognize hypnosis as a legitimate medical procedure. As an efficacious treatment modality, hypnotherapy belongs exclusively in the hands of qualified therapists.

Hypnotherapy has not yet been regulated in the UK. Most hypnotherapists are licensed medical doctors, registered nurses, social workers or family counsellors who have received additional training in hypnotherapy. The practice of hypnotherapy, however, entails virtually no standards or requirements for minimum training, practical experience, or demonstrated competence.

Costs and expenditures

The cost of a single hypnotherapy session will vary between countries and states, ranging from ~€30 to ~€400.

Does it work?

Due to the challenges of applying blinding, it is difficult to test the efficacy of hypnotherapy. The studies included in this summary therefore test the effectiveness of hypnotherapy.

Systematic reviews

One clinical review of medical research on hypnotherapy and relaxation therapies specifically for cancer patients was published in 1999.(12)The review concludes that "there is strong evidence from randomised trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, (adverse effects of chemotherapy) particularly in children." This review, however, only included three reviews, two randomised clinical trials and one NIH Technology Assessment, all published before 1999.

Clinical trials

A total of 22 randomised clinical trials and two controlled clinical trials report results of hypnotherapy used by cancer patients.(3,9,13-33) They include studies on hypnotherapy for anticipatory nausea and vomiting during medical procedures, cancer-related or treatment-related pain and other similar symptoms. The main results of the studies are described in Tables 1, 2 and 3.

The results of hypnotherapy interventions for anticipatory nausea and vomiting (ANV, n=6) during medical procedures suggest that a significant reduction of nausea was achieved in six studies, a reduction of emesis in five and a reduction of antiemetic use in one of the trials included (see Table 1).

Of the ten studies included in cancer-related pain, eight showed a significant reduction of pain, whereas another eight also showed a reduction of anxiety or pain-related anxiety when comparing the hypnotherapy group with the control groups (see Table 2).

With regards to studies on other cancer-related symptoms (n=7), two studies showed that hypnotherapy has the ability to improve symptoms of hot flashes (one study involved a combination with gabapentin), and another study showed improvements of radiotherapy-associated fatigue when combined with CBT (see Table 3).

Is it safe?

Hypnosis that is conducted under the care of a trained therapist or health care professional is considered safe.

Adverse events

Hypnotherapy has generally shown to have no specific adverse effects.(34,35)However, in adolescents, adverse reactions observed have included a dissociative state, depersonalization, anxiety and fearfulness.(36) Other adverse effects of hypnotherapy can include headache, dizziness, nausea, panic or the creation of false memories.

Contraindications

Acute psychoses, severe personality disorders and an inability to be hypnotized are considered contraindications.

Interactions

None known.

Warnings

Special precautions must be taken with people who have experienced trauma or abuse to ensure that they retain control over the depth of their trance and the issues being processed.

Evidence tables

Please view the PDFs listed below for details of the systematic reviews and/or controlled clinical trials included in this summary.

Citation

Document history

Revised in January 2016 by Markus Horneber.
Fully updated and revised in September 2014 by Katja Boehm.
Prevsiously updated and revised in August 2012 by Katja Boehm.Summary first published in September 2009, authored by Katja Boehm.

Zeltzer L, LeBaron S et al. The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy. Journal of Clinical Oncology : official journal of the American Society of Clinical Oncology 1984;6:683-90.

Zeltzer L, LeBaron S. Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. The Journal of Pediatrics 1982;101(6):1032-5.

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